# PEACOCK PHARMACY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Peacock Pharmacy,LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942528278
- **Authorized official:** DIANDRA BROOKS (PHARMACIST)
- **Authorized official phone:** (864) 596-4501

## Contact information

- **Practice address:** 550 S CHURCH ST STE 9, SPARTANBURG, SC 29306-3306
- **Practice address phone:** (864) 596-4501
- **Practice address fax:** (864) 596-4503
- **Mailing address:** 1201 HIGHWAY 37 19E, SUITE 3, ELIZABETHTON, TN 37643-4678
- **Mailing address phone:** (423) 542-2195

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 10993 | SC | Yes |
| 3336M0002X | Mail Order Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 05/11/2010
- **Last updated:** 09/01/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4229680 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |